Feline Compulsive Disorders

These are normal behaviors that have
been carried to such an extreme that they are damaging to the cat
(self-injurious behavior or SIB), or disturbing the human animal bond.The innate component of behaviors is encoded
in regions of the limbic system and hypothalamus, and the motor aspect
facilitated from the limbic system to the basal ganglia.The frontal cortex can activate or inhibit
any given behavior depending upon the circumstances.Normal behaviors such as grooming are triggered when they are
required and the situation permits.Anyone who has watched a cat is familiar with displacement
behavior.The cat is faced with a
dilemma requiring one of two or more conflicting behaviors that are virtually
indistinguishable in their desirability - perhaps to run and hide, or go and
explore something new and strange in their environment.In response the cat indulges in a behavior
unrelated to and precluding either of the conflicted behaviors – such as
licking its paw.It is theorized that
the neutralizing effect of the two conflicting behaviors disinhibits the
displacement behavior.If the conflict
is sustained then so is the tendency to perform the displacement behavior,
which can then become ingrained.Once
this has happened the displacement behavior will persist even after the
conflict has been resolved resulting in a compulsive behavior sometimes known
as a stereotypy.Besides grooming,
other hard-wired behaviors can also become compulsive, including predatory(both appetitive and consummatory
components), ingestive, locomotive, sleep, and maternal and sexual
behaviors.The form of the compulsive
behavior is generally species dependent, but is also dictated by the
experiences of and outside influences on the animal.In general, while injury may result from these behaviors it is
incidental not purposeful.

The successful treatment of OCDs has pointed to the involvement of three
main neurotransmitter systems - dopaminergic, serotonergic and opiate.Recently, it has been shown that nitric
oxide synthetase can have a significant effect on these behaviors, which
suggests that nitric oxide is also involved in regulation of some of these
conditions.OCD signs are exacerbated
by treatment with dopamine agonists.In
humans and rodents compulsive behaviors can be induced by large doses of
dopaminergic drugs - amphetamines, apomorphine.Dopamine injected into the caudate nucleus of the cat also
induces stereotypic behavior.Unfortunately, most compulsive behaviors do not respond to doses of
dopamine antagonists - haloperidol, acepromazine - at doses that do not also
induce sedation.The newer, atypical
neuroleptics such as clozapine and risperidone may be more effective, although
they have only been tried in a very limited number of cases to date.Many OCDs both in animals and humans respond
positively to treatment with SSRIs.Serotonin deregulation in the dorsal raphe nucleus or its targets in the
basal ganglia and cortex is thought to be important in the propagation of many
OCDs.Opioid antagonists - nalmefene,
naltrexone, naloxone and hydrocodone - have also proved effective in treating
some animal and human OCDs.Opioid
receptors are found in close association with dopaminergic and serotonergic
neurons in the limbic system, hypothalamus, striatum and periaqueductal gray
matter.Opioids facilitate dopaminergic
effector systems while serotonin acts as an antagonist.It has been suggested that the performance
of stereotypic behaviors may stimulate the release of endorphins and
enkephalins centrally, thereby rewarding the animal for its behavior and
reducing the tension it was experiencing.Over time, the animal performs the behavior in order to give itself a
high even when it is not stressed.Opioid antagonists have proven to have the greatest effect in cribbing
in horses, and a lesser effect in other oral behaviors such as feline wool
sucking and psychogenic alopecia.OCDs
do not generally resolve over time, and it is likely that, even with
environmental enrichment, the cat will be on medication for the rest of its
life, or relapse completely if the drugs are withdrawn.

Human and animal
compulsive disorders have one common characteristic - no single drug treatment
is effective in more than 60% of those affected.Augmentation with other types of drug may be helpful in the other
40%.The same behavior may result from
reduced serotonergic activity in one patient and increased dopaminergic or
opioid activity in another, although the presentation appears identical.In many of these disorders heredity seems to
play a role equally as or even more important than environment.This seems to be the case in wool
sucking.The duration of the disorder
can also influence the outcome of treatment.In general, pharmacological intervention is usually required to treat
compulsive disorders, but environmental enrichment and modification should not
be overlooked.Boredom,
attention-seeking behavior, separation anxiety and other stressors have all
been implicated in the pathogenesis of stereotypies.Neurological disease and tick borne pathogens should be ruled out
as causes for some.

In general, cats
are more likely to display biting/chewing behaviors, while dogs are more likely
to lick.Punishment and attempts to
stop the behavior are not effective.The animal may stop temporarily, but resume in another location away
from the owner.In some cases the
animal will respond with aggression to the owner’s attempts at interrupting.

Feline psychogenic
alopecia

This is a stress-linked self-grooming
behavior that appears to closely resemble trichotillomania (tearing out hair)
in humans.The cat’s excessive licking
and plucking pulls out hair in handfuls and leads to large areas of depilation
particularly over the limbs, flanks and abdomen.It is more likely to occur in cats that are subordinate and
friendly, and like most OCDs seems more common in the oriental breeds.Many cats start before they are a year old,
although onset can be at any age.Clinically other dermatological conditions, especially allergy and food
hypersensitivity, should be ruled out.(If the cat responds positively to steroids it wasn’t psychogenic
alopecia).However, the grooming can start
as the result of a dermatological condition, but persists as a compulsive disorder
after the underlying cause has been resolved.More typical stressors seem to be the arrival of new cats in the
household, the loss of old buddies that have died, or a change in schedule that
requires the prolonged absence of an owner.In general, the drug we will first recommend, once dermatological causes
have been ruled out, is clomipramine.However, this or fluoxetine do have the undesirable side effect in some
cats of turning them into recluses.Buspirone appears to be somewhat less effective in treating the
stereotypy, but usually produces marked improvement, and as an additional bonus
tends to make cats more friendly and out-going.

Part of a cat’s
grooming includes licking the nose and lips.This can develop into a compulsive behavior too, resulting in the
development of eosinophilic (rodent ulcers) or lip granulomas
respectively.Some cats progress to
sucking and chewing on the hair, as well as simply tearing it out.Others may groom their owner or another
animal excessively rather than or in addition to themselves.A yet-to-be-registered breed of cats called
the Ohos Azules have a propensity for grooming their owner’s hair, and will
persist day and night in their appointed behavior.This behavior appears to be inherited as a recessive trait.In another rare breed, the Singapura, this
also seems to be the case with psychogenic alopecia.Some Munchkin cats, an achondroplastic breed, exhibit compulsive
hoarding of jewelry and other small objects, and again the trait is
recessive.

Feline hyperesthesia
syndrome

This disease goes by a great number of names – as well as
feline hyperesthesia syndrome, it may also be referred to as rolling skin
disease, neurodermatitis, neuritis, feline psychomotor epilepsy and pruritic
dermatitis of Siamese cats.Despite the
last name, the condition has been reported in a number of different purebreds
as well as domestic long and shorthaired cats.The condition usually first appears when cats are between 1 and 5 years
of age, and occurs equally in both sexes.Attacks may occur more often in the evening and morning, but are not
seasonal.In some cats the condition
can be induced by petting or stroking them along the spine - hence the term
hyperesthesia.The observed behaviors
occur in all cats, but are taken to extremes in the cat with feline
hyperesthesia.The skin over the lumbar
region ripples, the cat looks at its tail, which may be held stiffly
erect.The cat then starts to growl and
attack its tail so aggressively that it may require amputation.(This is not curative, and the cat may
proceed to attack the stump or tail head.)Cats may also attack the flanks or pelvis.They are often very restless and vocal.Attacks and pacing may be interspersed with
periods of violent licking of the forelegs, base of the tail and chewing of the
claws. Cats may rush around attacking objects and people indiscriminately.In contrast, cats that are normally
aggressive may become unusually affectionate during bouts of hyperesthesia.Pupils are dilated and the eyes are
glassy.Owners often describe their
cats as being bewitched or hallucinating.A similarity to human schizophrenia has also been noted.Less commonly, definite prodromal signs may
precede frank seizures, and some cats exhibit uncontrolled urination and
defecation.Between attacks cats
generally appear to be normal.Attacks
can range in frequency from almost constant to relatively rare.Cats may become hyperthermic, probably as a
result of increased muscular activity during and right after episodes, but
there are no associated abnormalities on blood work.EEGs may show abnormal slow waves, dysrhythmias and spike
discharges.

The cause of feline
hyperesthesia syndrome is unclear.It
has been treated successfully in some cases as a partial seizure disorder with
phenobarbital (1-3mg/kg q 8h or 2-5mg/kg q12h) or primidone (0.5-3.0mg/kg q 8,
q 12 or q 24h as needed).In other
cats, this approach has had no effect.Some cases that had either failed to respond to phenobarbital or for
which no other treatment had been attempted have been controlledusing serotonin reuptake inhibitors
(clomipramine 0.5 - 1 mg/kg q 24h or fluoxetine 0.5mg/kg q 24h).

The primary rule
out for feline hyperesthesia is pansteatitis resulting from Vitamin E
deficiency.This condition results in
the deposition of a yellow pigment in fat cells that become inflamed and
undergo necrosis.This process
occurring in the subcutaneous fat layer causes skin hypersensitivity.Cats fed primarily canned red-meat tuna or
small amounts of other types of fish may exhibit this syndrome.

Case: Oscar was a
4.5year old, 13lb, castrated male, domestic short hair, inside-outside
cat.He had been spraying urine in the
house for about a year.For a few
months prior to presentation he had begun to attack the tip of his tail
viciously and had bitten through to the bone.Skin rippling preceded tail chasing.Oscar held his tail stiff, twitching the end, he would then start to
hiss at the tail before he launched his attack.Sometimes he would also attack his flanks and or he would chew
hard on his claws.Sometimes he would
attack the owner, particularly if she tried to stop his self-mutilation.Oscar was receiving 5mg of buspirone q
24h.This might have reduced his urine
spraying a little.However, it is far
less than the 10-20mg q 12h usually recommended for treating a cat of Oscar’s
size.Buspirone was withdrawn and Oscar
was started on a seventh of a 20mg capsule of fluoxetine q 24h.I felt that the new therapy would address
both his spraying and feline hyperesthesia.Initially, Oscar’s spraying seemed to increase; this was attributed to
withdrawal of the buspirone while fluoxetine levels were being
established.Spraying then rapidly
diminished and was eliminated when his dose of fluoxetine was increased to 5mg
q 24h one month after treatment was initiated.Tail chasing became more playful and less vicious.The owner noticed that Oscar was more likely
to engage in this behavior if it was too wet or snowy for him to go
outside.Introducing a cat dancer toy
also reduced aggressive attacks on the tail.After the dose of fluoxetine was increased, tail chasing virtually
disappeared.When it did occur it was not
preceded by skin rippling and seemed to represent grooming or playful behavior
only.The cat never displayed
aggression to his owner again after treatment had been initiated.

Tail chasing

Cats as well as dogs
can compulsively chase their tails to the point of inflicting damage, and even
necessitating amputation, which is non-curative.The use of E-collars may redirect the animal’s attention to
another part of the body that it can reach.In general, this is viewed as a compulsive hunting behavior.

Substrate sucking

Traditionally described as wool sucking, cats can chose any substrate
for their attentions, although wool, cotton, acrylic and interestingly plastic
are those most frequently seen.(Plastic may seem unusual in that cats generally avoid the material, and
placing plastic sheets in or under litter boxes has been implicated in many
cats choosing a different toilet area.)The oriental cats, particularly Siamese are most frequently diagnosed
with this problem - in one study 55% of 152 cats were Siamese, 28% Burmese, and
11% were oriental crossbreeds.93%
started on wool and many moved on to other materials, 64% ate cotton and 54%
synthetics.In general cats start by
sucking their own or another cat’s fur and mouthing it into wet tufts.Some will attempt to nurse on other cats or
the family dog.They may then start to
suck and knead on woolen (or other substrate) articles.The attention some cats show their owners’
hair may also be a variation of this.Items chosen run a complete gamut - blankets, sweaters, socks, exercise
clothing, underwear, shoelaces, sneakers, shower curtains, plastic bags
etc.Mouthing and chewing can also lead
to ingestion, and the risk of the cat’s g/i tract becoming blocked.

Because of the
similarities between this behavior and suckling in kittens, it has been
suggested that the problem arises because kittens are weaned much earlier in
captivity than in the free roaming state, where they often nurse until they are
6 months old.Neoteny of the oriental
breeds has also been cited as a cause; these breeds apparently need to nurse
for longer than domestic short and long hairs.

It has been
suggested that there are actually two behaviors being observed.Some cats chew rather than suck, and their
behavior is likened to that of feral or hunting cats that are chewing on their
prey.Providing cats that indulge in
this form with uncooked chicken bones with remnants of residual flesh has been
suggested as a more appropriate outlet for their needs.In some cases, introducing a high fiber diet
has proven effective in stopping substrate sucking, although the idea that cats
become hooked on the behavior to increase dietary fiber seems unlikely.